Health in Construction

A couple of weeks ago I travelled down to Birmngham to give a talk on behalf of the BOHS Breathe Freely initiative at the Health and Wellbeing event at the NEC. The Title of the talk was Managing Health in Construction – What Good Looks Like. An annotated version of the slides I used during the talk are now available on Slideshare

To prepare for the talk I did a little research on the meaures that are readily available to control exposure to contaminants, particularly dust, during common activities on construction sites. A number of studies have been done, both on-site and in the laboratory to assess the effectiveness of water supression and on-tool extraction for power tools. These studies have confirmed just how they can be.

For example

  • A large scale study in Ireland by Healy et al showed that the use of local extraction built into on-tool shrouds could reduce dust exposures by up to 99%
  • Laboratory tests by Thorpe et al showed water suppression on cut-off saws reduced dust levels by up to 99%

Despite this, in a large proportion of cases these engineering controls are not being used with reliance placed on respiratory protection which is often incorrectly used and inadequately managed. So one of the main aims of the BOHS Breathe Freely initiative is to raise awareness of the types of controls that can be used to reduce exposure. Hopefully in the not too distant future we’ll see water supression and on-tool extraction become the norm rather than the exception.

 

References

Measurements of the E€ectiveness of Dust Control on Cut-off€ Saws Used in the Construction Industry. Thorpe et al. Ann Occup Hyg Vol. 43, No. 7, pp. 443-456, 1999

An Evaluation of On-Tool Shrouds for Controlling Respirable Crystalline Silica in Restoration Stone Work.  Healy et al. Ann Occup Hyg 2014;58:1155-1167

Toxic Art – Alexander Calder’s Mercury Fountain

As an occupational hygienist, when visiting the Alexander Calder exhibition at Tate Modern last week I couldn’t help but stop and take notice of the pictures and description of one of the works created by this American artist well known for his mobiles and other “kinetic sculptures” . A mercury fountain.

While I was looking at the display, I overheard a comment by a young woman to her partner as they too read about this work

“It couldn’t have been real mercury could it. That would be dangerous”

I couldn’t help responding

“It was, and it is ”

Mercury, the magical Quicksilver, has been known since ancient times. A metal that’s a liquid at room temperature that flows like water.  Being a liquid, vapours are given off which can be inhaled and it can also be absorbed through intact skin. It’s highly toxic, affecting the brain, gastrointestinal system and kidneys. It’s particularly noted for causing neurological and behavioural disorders due to brain damage. Symptoms include tremors, insomnia, memory loss, neuromuscular effects, headaches and cognitive and motor dysfunction. In Victorian times mercury compounds were used in the manufacture of felt for hats and the workers in that industry were particularly affected. This is said to have inspired Lewis Carroll’s “Mad Hatter” from Alice’s Adventures in Wonderland. This was disputed by the esteemed Professor Hugh Waldron back in 1961, but the myth persists.

image

The exhibition website tells us the story of the fountain’s creation

In 1937 Calder was one of the contributors to the Pavilion of the Spanish Republic designed by Josep Lluís Sert for the International Exposition in Paris, where his Mercury Fountain was installed in proximity to Picasso’s painting Guernica. In the middle of the Spanish Civil War, Calder showed his support for the embattled Republic by creating a fountain that would run with mercury from the mines at Almadén – a valuable economic and strategic resource. (Tate website)

A 2007 study of historical exposures of the workers in Almadén mines to mercury indicated that had been very high

In the mine, the highest exposures occurred during drilling, with values up to 2.26 mg/m3 in air, 2194 μg/l in urine and 374 μg/l in blood. Furnace operation and cleaning were the tasks with the highest values in metallurgy, peaking up to 3.37 mg/m3. The filling of bottles with mercury by free fall gave values within a range of 1.13–2.43 mg/m3 in air; these values dropped to 0.32–0.83 mg/m3 after introducing a new ventilation system.

Occupational exposure limits for mercury are typically set at between 0.02 and 0.03mg/m3

I found it a little ironic that a work of art created in support of a government dedicated to improve the lot of working people celebrated an industry likely to have been responsible for poisoning the workers in the mine where it was extracted.

Although it seems likely that visitors to the exhibition back in the 1930’s would have been exposed to mercury vapours, given the relatively short period that they would have been in the vicinity their exposure would have been limited and its highly unlikely there would have been a significant risk to their health. However, I’d be more concerned about the staff working in the Spanish Pavilion.

Today the fountain can be seen at the Fundació Joan Miró museum in Barcelona – carefully displayed under glass. Hopefully appropriate measures are taken to protect the workers who have to maintain it from the toxic liquid and vapours.

Mercury fountain

Picture from the Fundació Joan Miró museum website

Heatwave in India – implications for workers

It’s rare that the concerns of ordinary workers makes the news in Europe, but over the past few days there have been reports in the British press about fatalities being caused by a severe heatwave in India.

india_heatwave

(Picture Source; www.commondreams)

According to the Guardian over 2,200 people have died

Andhra Pradesh has been hit the hardest, with 1,636 people dying from the heat over the past month and a half, a government statement said. A further 561 people have died in neighbouring Telangana, said Sada Bhargavi, a state disaster management commissioner.

Environmental conditions have been severe. The Guardian reports

Daytime temperatures hovered between 45C and 47C (113-116 F) in parts of the two states over the weekend, 3-7C (5-12F) above normal, said YK Reddy, a director of the Meteorological Centre in the Telangana state capital of Hyderabad.

The risk from heat stress depends not only on the environmental conditions but also on other factors, particularly

  • workload
  • clothing
  • individual susceptibility

Workers carrying out heavy work for prolonged periods in hot conditions are particularly at risk as they generate significant “internal” heat as well as absorbing it from the environment. Susceptible individuals include the elderly and people who are malnourished. Not surprisingly, then, the majority of the people who have died during the heatwave have been the elderly and manual labourers working outdoors.

01AgriculturalFieldworks&Kanchipuram&TN

Agricultural workers in India (source Wikipedia)

There are over 3 million construction workers employed in India (the figure is likely to be higher if “informal” workers are included) and many millions more working in agriculture (almost 50% of the workforce). Construction and agriculture are also major industries in other hot countries in the developing world, and there have been reports of numerous heat related illnesses and fatalities linked to manual work in hot conditions in countries such as Qatar, where there has been a boom in construction due to preparations for the 2022 World Cup.

2013-10-29-qat

Construction workers in Qatar (toehk under a Creative Commons Licence via New Internationalist)

The most effective ways to minimise the risks are to prevent exposure or to introduce engineering controls supplemented with work organisation and protective clothing. However engineering controls are impractical in most cases for outdoor workers in the developing world and the so the main way to minimise the risk of workers being adversely affected is to restrict the working time through work:rest regimes or “self pacing” and other administrative /management measures such as providing plenty of cool drinking water. In practice, most employers are unlikely to look favourably on this due to the impact on productivity and profitability. Subsistence farmers are unable to afford the technology available in the developed world (such as air conditioned cabs and automation) that could be applied to reduce their heat exposure and workload and need to work hard for long hours to have a chance of growing enough to survive.

Extreme events like the current heatwave in India are likely to become more frequent in the future due to climate change and it’s not just the developing world that will be affected. The populations of Europe and the United States are also likely to face exposure to heat extremes.

These events present challenges to occupational hygienists. First of all we currently don’t have an adequate method of evaluating the risk in these situations, particularly in the developing countries. The widely used WBGT index has serious limitations and the more complex Predicted Heat Strain Index is far too complex to be used in most situations. So work needs to be done to develop a suitable approach to risk assessment for the developing world. Secondly, given the scale of the problem, there’s a need to find appropriate, effective strategies to reduce and control exposures. Neither are easy tasks. However, some good work has been done on this in countries including India and Abu Dhabi and so the third challenge is persuading employers to adopt the guidance.

Who are Workplace Health Without Borders?

Workplace Health Without Borders (WHWB) is an organisation of occupational hygienists and other occupational health professionals who want to do something about the estimated 2 million people who die every year due to ill health caused by their work, and the countless millions of workers who suffer from work related illnesses. WHWB was established in Canada in 2011 and now has members in countries across the world.

The organisation’s stated mission is to work for a world where none is made ill by their work. A grand aim which will be far from easy to achieve. But WHWB are doing their part in trying to achieve it by working to transfer occupational hygiene expertise, training and resources to developing countries to help them to develop the capacity and local infrastructure to manage and improve health conditions in their workplaces.

whwb-slideshare-presentation-dec2014-48-638 (2)

Projects undertaken by WHWB members include

  • established a mentoring programme to provide support, advice and encouragement to occupational hygienists in the developing word
  • establishing a brick plant project to address silica and other hazards in brick plants in Nepal, Pakistan and Tanzania
  • providing technical support on silica dust monitoring in Pakistan
  • facilitated donations of occupational hygiene equipment to Uruguay, Pakistan and Tanzania
  • running the OHTA Basic Principles of Occupational Hygiene course in Tanzania
  • providing training on occupational hygiene to physicians in New Delhi, India
  • sponsored a workshop in India to raise awareness on silica exposure amongst stone crushers

WHWB also organise monthly teleconferences for their members across the globe to share knowledge and experience.

WHWB members attending the recent International Occupational Hygiene Association conference organised a lunchtime meeting to introduce interested delegates to the organisation, its aims, objectives, activities and projects. Over 50 delegates attended the meeting and there was a lot of enthusiasm for what WHWB are doing.

IOHA2015-540

WHWB co-sponsored the 7th International Control Banding Workshop in partnership with Medgate, which took place at the Conference, and there were also contributions from two WHWB members to the Conference programme. Kevin Hedges from Canada gave an Ignite presentation – Workplace Health Without Borders, Together We Will Make A Difference! – and Dave Zalk from the USA presented a scientific poster entitled Workplace Health Without Borders: Sharing occupational health and hygiene knowledge around the world.

Anyone interested in getting involved can sign up by visiting the WHWB website

Breathe Freely

On the evening of 28 April, Workers’ Memorial Day, the Breathe Freely initiative, which aims to raise awareness of respiratory disease in the construction industry, was launched at a reception at the Merchant Taylor’s Hall in London. The room was packed with 140 people, mainly representatives from the Construction industry.

IOHA2015-663

Breathe Freely is a collaborative initiative led by BOHS in partnership with key organisations within the construction industry. It will provide guidance, tools and resources that facilitate the recognition, evaluation and control of workplace exposures leading to the implementation of a recognised management standard. The aim is not just to raise awareness of the problem but also to effect action by providing practical solutions through sharing of best practice and encouraging implementation of effective exposure control.

Exposure to hazardous substances that can cause respiratory disease is a serious, but often unappreciated, risk for construction workers. However, the number of workers affected can be reduced dramatically if employers adopt good practice and introduce appropriate, cost effective, control measures.  The BOHS led Breathe Freely campaign will be a major step forward in highlighting both the risks and, very importantly, the measures that can be used to minimise them. Diamond Environmental is proud to be a supporter of the initiative

Night Shift Lullaby

There are relatively few good songs about work, even though it’s a major part of most people’s lives. This song, by the Magnolia Electric Company, is one of them and probably sums up the experience of many shift workers. Shift work can make it difficult to socialise, affect personal relationships and seriously disrupt family life. Shift work can also have an effect on health.

The UK Health and Safety Executive point out that

Research has shown that shifts, particularly night and early morning shifts, can have undesirable consequences for workers including disruption of the internal body clock, sleeping difficulties and fatigue. These in turn can affect performance, increase the likelihood of errors and accidents at work and might affect health and well-being.

Longer term effects, which are more difficult to confirm, may include adverse pregnancy outcomes, coronary heart disease, gastrointestinal disturbances.

Recent research has also suggested that shift workers are at higher risk of developing cancer. In particular, there is evidence from four studies of a link between breast cancer and shift work for female workers. Although there remains some doubt about this link the evidence was strong enough for the International Agency for Research on Cancer to conclude that  “shift work that involves circadian disruption is probably carcinogenic to humans” in 2007.

The reason for a link may not appear to be obvious at first but it has been suggested that altered light exposure at night on levels of melatonin or other hormones may be responsible.

Whatever the possible cause, if shift work is associated with breast cancer in women it isn’t going to be easy to eliminate or control. The top of the hierarchy of control is elimination – removing workers from the exposure that causes the disease. But banning women from night shift work would be highly controversial. More work would be needed to understand the causative factors so that other approaches to control can be developed.

A paper in the British Medical Journal (BMJ) discussing the link between shift work and cancer reviewed current approaches to control

increase sleep duration, promote quick adaptation to night work, or improve subjective wellbeing at work. One possibility is to use our increasing understanding of the physiological control of the sleep-wake cycle to time our exposure to light and darkness for maximum adaptation. Using phototherapy lamps (especially those producing blue light, which is most efficient in resetting melatonin release time), wearing goggles, wearing sunglasses when driving home, and darkening bedrooms or wearing sleeping masks are being tried. Medications that are stimulants, hypnotics, or chronobiotics (substances that control the body clock) are also being

The association between shift work and cancer hasn’t been proven conclusively yet. More work is needed. But, in any case further work is needed to develop appropriate control strategies to mitigate the known  and probable effects of shift work on health.

Further Reading

HSE guidance on shiftwork

HSE Research Report on shiftwork and breast cancer

IARC Monographs Volume 98

Shift work and cancer (BMJ 2009;339:b2653)

Long-term night shifts can “double” breast cancer risk

Dark Satanic Mills

image

Many people when they get to a certain age start to wonder where they came from. That was certainly true for me so a few years ago I started to research my family tree. Although there were a few surprises my research confirmed that I my family were ordinary workers. I wanted to find out about my roots, about my ancestors, where they came from and how they lived. And as an occupational hygienist I couldn’t help but be interested in what they did for a living and their working conditions.

Halifax Mill Chimneys

Coming from Lancashire it wasn’t a surprise to find that many of my ancestors who lived in the 19th and 20th Centuries were employed at some time during their lives in cotton mills. And working in cotton mills they were faced with a whole host of health risks.

I’ve always been interested in industry and when I was a boy my mother arranged for me to have a look round the mill where she worked. The first thing that hit me when I walked in the mill was the tremendous noise. Levels in weaving sheds were likely to be well above 90 dBA – often approaching, or even exceeding 100 dB(A). Communication was difficult and mill workers soon learned how to lip read and communicating with each other by “mee mawing” – a combination of exaggerated lip movements and miming

image

Not surprisingly many cotton workers developed noise induced hearing loss – one study in 1927 suggested that at least 27% of cotton workers in Lancashire suffered some degree of deafness. Personally, I think that’s an underestimation. This is how the term “cloth ears” entered the language – it was well known that workers in the mills were hard of hearing.

This lady is a weaver and is kissing the shuttle – sucking the thread through to load the shuttle ready for weaving.

image

This practice presented a number of health risks – the transmission of infectious diseases, such as TB, but as the shuttle would be contaminated with oil, and the oils used then were unrefined mineral oil – there was a risk of developing cancer of the mouth.

Exposure to oil occurred in other ways particularly for workers who had direct contact with machinery or where splashing of oil could occur. There was a high incidence of scrotal cancer in men who operated mule spinners – and this was a problem even in the 1920s. In earlier times workers in mills had to work in bare feet as the irons on their clogs could create sparks which could initiate a fire due to the floorboards being soaked with oil. Contact with these very oil soaked floorboards led to cases of foot cancer.

image

And of course there was the dust. Exposure to cotton dust, particularly during early stages of production, can lead to the development of byssinosis – a debilitating respiratory disease. An allergic condition, it was often known as “Monday fever” as symptoms were worst on Mondays, easing off during the week. A study on 1909 reported that around 75% of mill workers suffered from respiratory disease.

image

The worst areas for dust exposures were the carding rooms where the cotton was prepared ready for spinning, but dust levels could be high in spinning rooms too.

image

Although control measures started to be introduced in the 1920’s workers continued to be exposed to dust levels that could cause byssinosis. Studies in the 1950’s showed  than more than 60% of card room workers developed the disease as well as around 10 to 20% of workers in some spinning rooms.

image

A lot of work was devoted to studying dust levels, developing standards and control measures by the early pioneers of occupational hygiene in the UK and I’m sure this contributed to improved conditions in the cotton industry in the UK. I’m not sure I’d like to have to operate their dust sampling kit though – it certainly wasn’t personal sampling!

image

Today things are different. The carding machines, spinning frames and looms are silent and have been sent for scrap. The mills have been abandoned and are derelict or demolished or have been converted for other uses.

image

Cotton is still in demand but it’s a competitive market and the work has been moved to other countries where labour is cheap and standards are not as high – Africa, China and the Indian sub-continent. Another consequence of globalisation. Although you could say that the industry is returning to where it originated in the days before the industrial revolution. Sadly, conditions and working methods in many workplaces in the developing world are primitive and controls are minimal. It seems like the lessons learned in the 20th Century in the traditional economies are rarely applied so not surprisingly those traditional diseases associated with the industry are re-emerging in developing economies.

image

Studies carried out in recent years have shown high incidences of byssinosis in some mills developing countries. One study in Karachi, Pakistan in 2008 found that among 362 textile workers 35.6% had byssinosis. (Prevalence of Byssinosis in Spinning and Textile Workers of Karachi, Pakistan, Archives of Environmental & Occupational Health, Vol. 63, No. 3, 2008 ). A study of textile workers in Ethiopia published in 2010 showed a similar proportion – 38% had developed byssinosis,  with 84.6% of workers in the carding section suffering from the disease

image

Another study, this time into textile workers’ noise exposures in Pakistan indicated noise levels in the range 88.4-104 dB(A). 57% were unaware that noise caused hearing damage and almost 50% didn’t wear ear defenders

William Blake wrote of “Dark Satanic Mills” in 1804. This was still a fair description of the working conditions in Lancashire when my ancestors worked in the mills. And I believe its valid today in many workplaces in the developing world.

image

It’s not easy to get accurate figures on occupational health in the UK and so much more difficult in the developing world. The best estimate we have (and it’s likely to be an underestimate) is that 2.3 million people die due to accidents at work and work related disease (World health Organisation). And the vast majority of these are due to ill health

image 

 

Some occupational hygienists might take a dispassionate, academic interests in dust exposure. But I think most of us are motivated by a genuine desire to prevent ill health at work and improve working conditions. Many of us work in countries where conditions although far from perfect are relatively good. But can we turn a blind eye to what’s happening in the rest of the world?

Personally, I think it’s something we need to be thinking about.